US20050038048A1 - Use of 7h-pyrrollo{2,3-d}pyrimidine derivatives in the treatment of solid tumor diseases - Google Patents
Use of 7h-pyrrollo{2,3-d}pyrimidine derivatives in the treatment of solid tumor diseases Download PDFInfo
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- US20050038048A1 US20050038048A1 US10/493,787 US49378704A US2005038048A1 US 20050038048 A1 US20050038048 A1 US 20050038048A1 US 49378704 A US49378704 A US 49378704A US 2005038048 A1 US2005038048 A1 US 2005038048A1
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- carbamoyl
- lower alkyl
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- 0 *CCC1=NC=NC2=C1C=C(C1=CC=CC=C1)N2.[1*]N([2*])CC Chemical compound *CCC1=NC=NC2=C1C=C(C1=CC=CC=C1)N2.[1*]N([2*])CC 0.000 description 6
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
- A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
- A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P35/00—Antineoplastic agents
- A61P35/04—Antineoplastic agents specific for metastasis
Definitions
- This invention relates to a method for the treatment of patients suffering from a solid tumor disease selected from carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, head and neck cancer, especially squamous cell head and neck cancer, lung cancer, especially non small cell lung cancer (NSCLC), tumors of the gastrointestinal tract, glioma and mesothelioma comprising administering a 7H-pyrrolo[2,3-d]pyrimidine derivative, or a pharmaceutically acceptable salt thereof, in particular using an improved regimen for the administration of such 7H-pyrrolo[2,3-d]pyrimidine derivative.
- a solid tumor disease selected from carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, head and neck cancer, especially squamous cell head and neck cancer, lung cancer, especially non small cell lung cancer (NSCLC), tumors of the gastrointestinal tract, glioma and mesothelioma
- NSCLC non small cell lung cancer
- 7H-pyrrolo[2,3-d]pyrimidine derivatives useful for treating tumor diseases and other conditions are, e.g., disclosed in U.S. Pat. No. 6,140,332, which is here incorporated by reference in its entirety.
- Such 7H-pyrrolo[2,3-d]pyrimidine derivatives are described in such patent to be useful for the treatment of benign or malignant tumours being capable of effecting tumour regression and of preventing the formation of tumour metastases and the growth of micrometastases.
- such compounds can be used especially in the case of epidermal hyperproliferation (psoriasis), in the treatment of neoplasias of epithelial character, e.g. mammary carcinomas, and in leukaemias.
- U.S. Pat. No. 6,140,332 discloses that the 7H-pyrrolo[2,3-d]pyrimidine derivatives are administered in the case of an individual having a body weight of about 70 kg at a daily dose from approximately 0.1 grams to approximately 5 grams, preferably from about 0.5 grams to 2 grams. It is not suggested that the 7H-pyrrolo[2,3-d]pyrimidine derivative should be administered on alternate days.
- the present invention relates to the use of a 7H-pyrrolo[2,3-d]pyrimidine derivative, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the treatment of carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, head and neck cancer, especially squamous cell head and neck cancer, lung cancer, especially non small cell lung cancer (NSCLC), tumors of the gastrointestinal tract, glioma or mesothelioma.
- NSCLC non small cell lung cancer
- the present invention relates to a method for the treatment of patients suffering from a solid tumor disease selected from renal carcinoma, squamous cell carcinoma of the skin, head and neck cancer, especially squamous cell head and neck cancer, lung cancer, especially NSCLC, tumors of the gastrointestinal tract, glioma and mesothelioma comprising administering a 7H-pyrrolo[2,3-d]pyrimidine derivative, or a pharmaceutically acceptable salt thereof, in particular using an improved regimen for the administration of such 7H-pyrrolo[2,3-d]pyrimidine derivative as described herein.
- a solid tumor disease selected from renal carcinoma, squamous cell carcinoma of the skin, head and neck cancer, especially squamous cell head and neck cancer, lung cancer, especially NSCLC, tumors of the gastrointestinal tract, glioma and mesothelioma
- administering a 7H-pyrrolo[2,3-d]pyrimidine derivative, or a pharmaceutically acceptable salt thereof in particular using an improved
- the present invention further relates to a method of inhibiting metastatic growth in a patient with a solid tumor disease as defined herein which comprises administering a pharmaceutically effective amount of a 7H-pyrrolo[2,3-d]pyrimidine derivative or a pharmaceutically acceptable salt thereof, to the patient, in particular using an improved regimen for the administration of such 7H-pyrrolo[2,3-d]pyrimidine derivative as described herein.
- the compound (R)-6-(4-hydroxy-phenyl)-4-[(1-phenyl-ethyl)-amino]-7H-pyrrolo[2,3-d]pyrimidine, or a pharmaceutically acceptable salt therof is the preferred 7H-pyrrolo[2,3-d]pyrimidine derivative, which compound is described in Example 39 of WO 97/02266.
- the compound is also known in the art as “PKI166” or “CGP 75166”.
- a further aspect of the present invention is a method of inhibiting metastatic growth in a patient with a solid tumor disease selected from carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, tumors of the gastrointestinal tract, mesothelioma, esophageal tumors, stomach cancer, small-bowel tumors and large-bowel tumors such as polyps of the colon and rectum, and anorectal cancer
- week means seven consecutive days. Thus, a three week period is twenty-one consecutive days starting on any day of the calendar week. The day that the first dose is given is considered to be the first day of the week. Any discussion using calendar weeks is intended to be for illustrative purposes only.
- mesothelioma means a malignant tumor derived from mesothelial tissue (peritoneum, pleura, pericardium).
- glioma preferably includes all primary intrinsic neoplasms of the brain and spinal cord, e.g. astrocytomas, ependymomas, neurocytomas or meningiomas.
- tumors of the gastrointestinal tract includes, but is not limited to esophageal tumors, stomach cancer, small-bowel tumors and large-bowel tumors such as polyps of the colon and rectum, colorectal cancer and anorectal cancer.
- partial response means a greater than or equal to 50% reduction in measurable or evaluable disease in the absence of progression in any particular disease site.
- stable disease means a less than 50% decrease or less than 25% increase in measurable or evaluable disease.
- Asymmetric carbon atoms of a compound of formula I that are optionally present may exist in the (R), (S) or (R,S) configuration, preferably in the (R) or (S) configuration. Substituents at a double bond or a ring may be present in cis- ( ⁇ Z—) or trans ( ⁇ E—) form.
- the compounds may thus be present as mixtures of isomers or preferably as pure isomers.
- alkyl contains up to 20 carbon atoms and is most preferably lower alkyl.
- the prefix “lower” denotes a radical having up to and including a maximum of 7, especially up to and including a maximum of 4 carbon atoms, the radicals in question being either unbranched or branched with single or multiple branching.
- Lower alkyl is, for example, methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, tert-butyl, n-pentyl, isopentyl, neopentyl, n-hexyl or n-heptyl.
- Alkyl R 1 and R 2 independently of each other are preferably methyl, ethyl, isopropyl or tert-butyl, especially methyl or ethyl.
- Lower alkyl Y is preferably methyl, ethyl or propyl.
- Lower alkoxy is for example ethoxy or methoxy, especially methoxy.
- Substituted alkyl is preferably lower alkyl as defined above where one or more, preferably one, substituents may be present, such as e.g. amino, N-lower alkylamino, N,N-di-lower alkylamino, N-lower alkanoylamino, N,N-di-lower alkanoylamino, hydroxy, lower alkoxy, lower alkanoyl, lower alkanoyloxy, cyano, nitro, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, amidino, guanidino, ureido, mercapto, lower alkylthio, halogen or a heterocyclic radical.
- substituents such as e.g. amino, N-lower alkylamino, N,N-di-lower alkyla
- Substituted alkyl R 1 and R 2 are independently of each other preferably hydroxy-lower alkyl, N,N-di-lower alkylamino-lower alkyl or morpholinyl-lower alkyl.
- R 1 or R 2 contains from 3 up to 20 carbon atoms and is especially unsubstituted or also substituted C 3 -C 6 cycloalkyl wherein the substituents are selected from e.g.
- Mono- or disubstituted amino is amino substituted by one or two radicals selected independently of one another from e.g. unsubstituted or substituted lower alkyl.
- Disubstituted amino R 4 is preferably N,N-di-lower alkylamino, especially N,N-dimethylamino or N,N-diethylamino.
- a heterocyclic radical contains especially up to 20 carbon atoms and is preferably a saturated or unsaturated monocyclic radical having from 4 or 8 ring members and from 1 to 3 heteroatoms which are preferably selected from nitrogen, oxygen and sulfur, or a bi- or tri-cyclic radical wherein, for example, one or two carbocyclic radicals, such as e.g. benzene radicals, are annellated (fused) to the mentioned monocyclic radical. If a heterocyclic radical contains a fused carbocyclic radical then the heterocyclic radical may also be attached to the rest of the molecule of formula I via a ring atom of the fused carbocyclic radical.
- the heterocyclic radical (including the fused carbocyclic radical(s) if present) is optionally substituted by one or more, preferably by one or two, radicals such as e.g. unsubstituted or substituted lower alkyl, amino, N-lower alkylamino, N,N-di-lower alkylamino, N-lower alkanoylamino, N,N-di-lower alkanoylamino, hydroxy, lower alkoxy, lower alkanoyl, lower alkanoyloxy, cyano, nitro, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, amidino, guanidino, ureido, mercapto, lower alkylthio, or halogen.
- radicals such as e.g. unsubstituted or substituted lower
- a heterocyclic radical is pyrrolidinyl, piperidyl, lower alkyl-piperazinyl, di-lower alkyl-piperazinyl, morpholinyl, tetrahydropyranyl, pyridyl, pyridyl substituted by hydroxy or lower alkoxy, or benzodioxolyl, especially pyrrolidinyl, piperidyl, lower alkyl-piperazinyl, di-lower alkyl-piperazinyl or morpholinyl.
- a heterocyclic radical R 1 or R 2 is as defined above for a heterocyclic radical with the proviso that it is bonded to the rest of the molecule of formula I via a ring carbon atom.
- a heterocyclic radical R 1 or R 2 is lower alkyl-piperazinyl or especially preferred tetrahydropyranyl. If one of the two radicals R 1 and R 2 represents a heterocyclic radical, the other is preferably hydrogen.
- a heterocyclic radical R 3 is as defined above for a heterocyclic radical with the proviso that it is bonded to Q via a ring carbon atom if X is not present.
- a heterocyclic radical R 3 is benzodioxolyl, pyridyl substituted by hydroxy or lower alkoxy, or especially preferred indolyl substituted by halogen and lower alkyl. If R 3 is pyridyl substituted by hydroxy then the hydroxy group is preferably attached to a ring carbon atom adjacent to the ring nitrogen atom.
- a heterocyclic radical R 4 is as defined above for a heterocyclic radical and is preferably pyrrolidinyl, piperidyl, lower alkyl-piperazinyl, morpholinyl or pyridyl.
- the heterocyclic radical is as defined above for a heterocyclic radical and represents preferably pyrrolidinyl, piperidyl, lower alkyl-piperazinyl, di-lower alkyl-piperazinyl or morpholinyl.
- An unsubstituted or substituted aromatic radical R 3 has up to 20 carbon atoms and is unsubstituted or substituted, for example in each case unsubstituted or substituted phenyl.
- an unsubstituted aromatic radical R 3 is phenyl.
- a substituted aromatic radical R 3 is preferably phenyl substituted by one or more substituents selected independently of one another from the group consisting of unsubstituted or substituted lower alkyl, amino, N-lower alkylamino, N,N-di-lower alkylamino, N-lower alkanoylamino, N,N-di-lower alkanoylamino, hydroxy, lower alkoxy, lower alkanoyl, lower alkanoyloxy, cyano, nitro, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, amidino, guanidino, ureido, mercapto, lower alkylthio and halogen.
- a substituted aromatic radical R 3 is phenyl substituted by one or more radicals selected independently of one another from the group consisting of lower al
- Halogen is primarily fluoro, chloro, bromo or iodo, especially fluoro, chloro or bromo.
- C 1 -C 7 -alkylene may be branched or unbranched and is in particular C 1 -C 3 -alkylene.
- C 1 -C 7 -alkylene G is preferably C 1 -C 3 -alkylene, most preferably methylene (—CH 2 —).
- G is not C 1 -C 7 -alkylene it preferably represents —C( ⁇ O)—.
- C 1 C 7 -alkylene X is preferably C 1 -C 3 -alkylene, most preferably methylene (—CH 2 —) or ethan-1,1-diyl (—CH(CH 3 )—).
- Q is preferably —NH—.
- Z is preferably oxygen or sulfur, most preferably oxygen.
- Salts are especially the pharmaceutically acceptable salts of compounds of formula I.
- the compounds of formula I or salts thereof are prepared in accordance with processes known per se (see also EP 682 027, WO 97/02266, WO 97/27199 and WO 98/07726), though not previously described for the manufacture of the compounds of the formula I, especially whereby in order to prepare a compound of formula I, wherein G is C 1 -C 7 -alkylene and wherein R 1 and R 2 are each independently of the other hydrogen, unsubstituted or substituted alkyl or cycloalkyl, or a heterocyclic radical bonded via a ring carbon atom, with the proviso that R 1 and R 2 are not both hydrogen, or wherein R 1 and R 2 together with the nitrogen atom to which they are attached form a heterocyclic radical, a compound of the formula II wherein Hal is halogen, G is C 1 -C 7 -alkylene and R 3 , Q and X have the meanings as defined for a compound of formula I, is reacted with a compound of
- the reaction between a compound of formula II and a compound of formula III preferably takes place in a suitable inert solvent, especially N,N-dimethylformamide, in the presence of a base such as potassium carbonate, at temperatures from room temperature (RT) to 100° C.
- a suitable inert solvent especially N,N-dimethylformamide
- the reaction between a compound of formula II and a compound of formula III takes place in a suitable solvent, e.g. lower alcohols, such as ethanol, in the presence of for example a suitable catalyst such as NaI, preferably at the reflux temperature of the solvent employed.
- a suitable solvent e.g. lower alcohols, such as ethanol
- a suitable catalyst such as NaI
- functional groups of the starting compounds which should not take part in the reaction may be present in unprotected form or may be protected for example by one or more protecting groups.
- the protecting groups are then wholly or partly removed according to one of the known methods.
- protecting groups and the manner in which they are introduced and removed are described, for example, in “Protective Groups in Organic Chemistry”, Plenum Press, London, New York 1973, and in “Methoden der organischen Chemie”, Houben-Weyl, 4th edition, Vol. 15/1, Georg-Thieme-Verlag, Stuttgart 1974 and in Theodora W. Greene, “Protective Groups in Organic Synthesis”, John Wiley & Sons, New York 1981.
- a characteristic of protecting groups is that they can be removed readily, i.e. without the occurrence of undesired secondary reactions, for example by solvolysis, reduction, photolysis or alternatively under physiological conditions.
- end products of formula I may however also contain substituents that can also be used as protecting groups in starting materials for the preparation of other end products of formula I.
- substituents that can also be used as protecting groups in starting materials for the preparation of other end products of formula I.
- a readily removable group that is not a constituent of the particular desired end product of formula I is designated a “protecting group”, unless the context indicates otherwise.
- All process steps described here can be carried out under known reaction conditions, preferably under those specifically mentioned, in the absence of or usually in the presence of solvents or diluents, preferably those that are inert to the reagents used and able to dissolve them, in the absence or presence of catalysts, condensing agents or neutralising agents, for example ion exchangers, typically cation exchangers, for example in the H + form, depending on the type of reaction and/or reactants at reduced, normal, or elevated temperature, for example in the range from ⁇ 100° C. to about 190° C., preferably from about ⁇ 80° C.
- the starting materials used in the above described processes a) to b) are known, capable of being prepared according to known processes (see also EP 682 027, WO 97/02266, WO 97/27199 and WO 98/07726), or commercially obtainable; in particular, they can be prepared using processes as described in the Examples.
- a compound of formula II can be prepared for example by reacting a compound of formula VII wherein G is C 1 -C 7 -alkylene and R 3 , Q and X have the meanings as defined for a compound of formula I, with e.g. thionyl halogenide, preferably thionyl choride, in the presence or absence of pyridine, in an inert solvent, for example toluene or in a 1:1 mixture of acetonitrile and dioxane, preferably at ⁇ 10 to 0° C. or at RT.
- thionyl halogenide preferably thionyl choride
- a compound of formula VII can be prepared for example by reacting a compound of formula VIII wherein R 5 is lower alkyl, especially methyl or ethyl, and R 3 , Q and X have the meanings as defined for a compound of formula I, with lithium aluminium hydride, in an inert solvent, especially ethers, e.g. cyclic ethers such as tetrahydrofuran, preferably at the reflux temperature of the solvent employed.
- an inert solvent especially ethers, e.g. cyclic ethers such as tetrahydrofuran, preferably at the reflux temperature of the solvent employed.
- a compound of formula VII may be prepared by reacting a compound of formula VIII with diisobutyl-aluminium hydride, in an inert solvent, for example in tetrahydrofuran or in a 1:1 mixture of dichloromethane and dioxane, preferably at RT.
- a compound of formula VIII wherein Q is —NH— can be prepared for example by reacting a compound of formula IX wherein Hal is halogen, preferably chloro, and R 5 is as defined above for a compound of formula VIII, with a compound of the formula H 2 N—X—R 3 , wherein R 3 and X have the meanings as defined for a compound of formula I, (i) in a suitable solvent such as alcohols, especially lower alcohols such as n-butanol, preferably at the boiling temperature of the solvent employed or (ii) under catalytic conditions.
- a suitable solvent such as alcohols, especially lower alcohols such as n-butanol, preferably at the boiling temperature of the solvent employed or (ii) under catalytic conditions.
- a compound of formula VIII wherein Q is —O— can be prepared for example by reacting a compound of formula IX, which is preferably N-protected in the pyrrolo-pyrimidine moiety, with a compound of the formula HO—X—R 3 , wherein R 3 and X have the meanings as defined for a compound of formula I, in a suitable inert solvent such as N,N-dimethylformamide and in the presence of a base such as potassium carbonate, at elevated temperatures, preferably at around 100° C.
- a suitable inert solvent such as N,N-dimethylformamide
- a base such as potassium carbonate
- the carboxylic acid ester of a compound of formula IX may first be reduced to the corresponding alcohol, e.g. under conditions described above for the preparation of a compound of formula VII, and then either be reacted with a compound of the formula H 2 N—X—R 3 , e.g. under conditions described above for the preparation of a compound of formula VIII wherein Q is —NH—, or be reacted with a compound of the formula HO—X—R 3 , e.g. under conditions described above for the preparation of a compound of formula VIII wherein Q is —O—.
- a compound of formula I, or a pharmaceutically acceptable salt thereof, can be used in pharmaceutical compositions known as such.
- Compositions for enteral administration such as nasal, buccal, rectal or, especially, oral administration, and for parenteral administration, such as intravenous, intramuscular or subcutaneous administration, to warm-blooded animals, especially humans, are especially preferred.
- the compositions contain the active ingredient alone or, preferably, together with a pharmaceutically acceptable carrier. The dosage of the active ingredient depends upon the disease to be treated and upon the species, its age, weight, and individual condition, the individual pharmacokinetic data, and the mode of administration.
- the pharmaceutical compositions comprise from approximately 1% to approximately 95% active ingredient, single-dose administration forms comprising in the preferred embodiment from approximately 20% to approximately 90% active ingredient and forms that are not of single-dose type comprising in the preferred embodiment from approximately 5% to approximately 20% active ingredient.
- Unit dose forms are, for example, coated and uncoated tablets, ampoules, vials, suppositories or capsules. Examples are capsules containing from about 0.05 g to about 1.0 g of active substance.
- compositions of the present invention are prepared in a manner known per se, for example by means of conventional mixing, granulating, coating, dissolving or lyophilising processes.
- the solid tumor disease to be treated is renal cell cancer. In another preferred embodiment of the invention, the solid tumor disease to be treated is NSCLC. In a further preferred embodiment of the invention, the solid tumor disease to be treated is selected from skin squamous cell carcinoma and head and neck squamous cell carcinoma. In another preferred embodiment of the invention, the solid tumor disease is anorectal cancer, especially anorectal adenocarcinoma and squamous cell carcinoma of the anal canal and margin and metastasis thereof.
- the present invention relates to a treatment regimen whereby the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered to the human subject less frequently than on a daily basis.
- the present invention relates to a treatment regimen whereby over at least a three week period, the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered on only about 40% to about 71% of the days.
- the present invention relates to a method of treating a human subject with a 7H-pyrrolo[2,3-d]pyrimidine derivative, which comprises administering such pyrimidine derivative to the human subject from three to five times in each seven day period for a period of three weeks or longer, more specifically, three or four times a week on alternate days for a period of three weeks or longer.
- the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered three times each week on alternate days, for example, on Monday, Wednesday and Friday of each week, for at least three weeks.
- the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered every other day until three doses are given and the next dose is administered at the beginning of the following week.
- dosage regimen is carried out through at least four or more weeks, for example 4, 5, 6, 7 or 8 weeks.
- the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered daily for a period of one to three weeks, e.g. two weeks, followed by a period of one to three weeks, e.g. two weeks without administering the compound to the patient.
- the present invention relates especially to a method of treating a solid tumor disease as defined herein, which comprises administering a pharmaceutically effective amount of (R)-6-(4-hydroxy-phenyl)-4-[(1-phenyl-ethyl)-amino]-7H-pyrrolo[2,3-d]pyrimidine, or a salt thereof, to a human subject, preferably three or four times a week on alternate days, more preferably three times a week on alternate days, for a period of three weeks or longer.
- the inventive dosage regimen applies to the use of 7H-pyrrolo[2,3-d]pyrimidine derivative, for example, PKI166, alone, or as part of a combination treatment therapy wherein it is co-administered with one or more additional pharmaceutical products useful for treating tumors, especially cancerous tumors.
- co-administered means that the patient is treated with both drugs according to the proper schedule for each, but not necessarily that both drugs are administered together at the same time.
- the 7H-pyrrolo[2,3-d]pyrimidine derivative may be administered alone or in combination with other anticancer agents, e.g. in accordance with the present inventive dosage regimen.
- the 7H-pyrrolo[2,3-d]pyrimidine derivative is advantageously administered to the human subject at a pharmaceutically effective dosage in the range of from about 50 mg to about 2000 mg on days when the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered.
- the preferred effective dose is in the range from about 50 mg to about 2000 mg, for example, about 450 mg to about 1500 mg doses or about 500 mg to about 1200 mg doses.
- the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered to the subject by methods known in the art for administering pharmaceutical products, for example, orally, rectally or parenterally, preferably orally as a tablet or capsule formulation.
- the 7H-pyrrolo[2,3-d]pyrimidine derivative can be administered as described in WO 97/02266.
- Step 1.1 4-[4-((R)-1-Phenyl-ethylamino)-7H-pyrrolo[2,3-d]pyrimidin-6-yl]-benzoic acid ethyl ester
- Step 1.2 ⁇ 4-[4-((R)-1-Phenyl-ethylamino)-7H-pyrrolo[2,3-d]pyrimidin-6-yl]-phenyl ⁇ -methanol
- Step 1.3 [6-(4-Chloromethyl-phenyl)-7H-pyrrolo[2,3-d]pyrimidin-4-yl]-((R)-1-phenyl-ethyl)-amine
- a human patient suffering from renal cell cancer is treated for a period of 16 weeks in 4 cycles consisting of administration of 600 mg of PKI166 daily for two weeks followed by 2 weeks without administering the drug. During such 16 weeks a stable disease is observed.
- a human patient suffering from renal cell cancer is treated for a period of 16 weeks with 400 mg of PKI166 on Monday, Wednesday and Friday of each week. During such 16 weeks a stable disease is observed.
- a human patient suffering from NSCLC is treated for a period of 8 weeks with 450 mg/day of PKI166 except on day 2, 16 and 30 on which days no drug is applied. After such treatment a partial response is observed.
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Abstract
Patients suffering from a solid tumor disease selected from carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, head and neck cancer, especially squamous cell head and neck cancer, lung cancer, especially non small cell lung cancer (NSCLC), tumors of the gastrointestinal tract, glioma and mesothelioma or metastases of such solid tumor diseases are treated with a 7H-pyrrolo[2,3-d]pyrimidine derivative.
Description
- This invention relates to a method for the treatment of patients suffering from a solid tumor disease selected from carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, head and neck cancer, especially squamous cell head and neck cancer, lung cancer, especially non small cell lung cancer (NSCLC), tumors of the gastrointestinal tract, glioma and mesothelioma comprising administering a 7H-pyrrolo[2,3-d]pyrimidine derivative, or a pharmaceutically acceptable salt thereof, in particular using an improved regimen for the administration of such 7H-pyrrolo[2,3-d]pyrimidine derivative.
- 7H-pyrrolo[2,3-d]pyrimidine derivatives useful for treating tumor diseases and other conditions are, e.g., disclosed in U.S. Pat. No. 6,140,332, which is here incorporated by reference in its entirety. Such 7H-pyrrolo[2,3-d]pyrimidine derivatives are described in such patent to be useful for the treatment of benign or malignant tumours being capable of effecting tumour regression and of preventing the formation of tumour metastases and the growth of micrometastases. According to such patent such compounds can be used especially in the case of epidermal hyperproliferation (psoriasis), in the treatment of neoplasias of epithelial character, e.g. mammary carcinomas, and in leukaemias.
- Furthermore, U.S. Pat. No. 6,140,332 discloses that the 7H-pyrrolo[2,3-d]pyrimidine derivatives are administered in the case of an individual having a body weight of about 70 kg at a daily dose from approximately 0.1 grams to approximately 5 grams, preferably from about 0.5 grams to 2 grams. It is not suggested that the 7H-pyrrolo[2,3-d]pyrimidine derivative should be administered on alternate days.
- Surprisingly, it was now found that 7H-pyrrolo[2,3-d]pyrimidine derivatives are suitable for the treatment of the solid tumor diseases mentioned herein. Thus, the present invention relates to the use of a 7H-pyrrolo[2,3-d]pyrimidine derivative, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the treatment of carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, head and neck cancer, especially squamous cell head and neck cancer, lung cancer, especially non small cell lung cancer (NSCLC), tumors of the gastrointestinal tract, glioma or mesothelioma.
- Furthermore, the present invention relates to a method for the treatment of patients suffering from a solid tumor disease selected from renal carcinoma, squamous cell carcinoma of the skin, head and neck cancer, especially squamous cell head and neck cancer, lung cancer, especially NSCLC, tumors of the gastrointestinal tract, glioma and mesothelioma comprising administering a 7H-pyrrolo[2,3-d]pyrimidine derivative, or a pharmaceutically acceptable salt thereof, in particular using an improved regimen for the administration of such 7H-pyrrolo[2,3-d]pyrimidine derivative as described herein.
- The present invention further relates to a method of inhibiting metastatic growth in a patient with a solid tumor disease as defined herein which comprises administering a pharmaceutically effective amount of a 7H-pyrrolo[2,3-d]pyrimidine derivative or a pharmaceutically acceptable salt thereof, to the patient, in particular using an improved regimen for the administration of such 7H-pyrrolo[2,3-d]pyrimidine derivative as described herein.
- In the present invention, the compound (R)-6-(4-hydroxy-phenyl)-4-[(1-phenyl-ethyl)-amino]-7H-pyrrolo[2,3-d]pyrimidine, or a pharmaceutically acceptable salt therof, is the preferred 7H-pyrrolo[2,3-d]pyrimidine derivative, which compound is described in Example 39 of WO 97/02266. The compound is also known in the art as “PKI166” or “CGP 75166”.
-
- R1 and R2 are each independently of the other hydrogen, unsubstituted or substituted alkyl or cycloalkyl, a heterocyclic radical bonded via a ring carbon atom, or a radical of the formula R4—Y—(C═Z)— wherein R4 is unsubstituted, mono- or disubstituted amino or a heterocyclic radical, Y is either not present or lower alkyl and Z is oxygen, sulfur or imino, with the proviso that R1 and R2 are not both hydrogen; or
- R1 and R2 together with the nitrogen atom to which they are attached form a heterocyclic radical;
- R3 is a heterocyclic radical or an unsubstituted or substituted aromatic radical;
- G is C1-C7-alkylene, —C(═O)—, or C1-C6-alkylene-C(═O)— wherein the carbonyl group is attached to the NR1R2 moiety;
- Q is —NH— or —O—, with the proviso that Q is —O— if G is —C(═O)— or C1-C6-alkylene-C(═O)—; and
- X is either not present or C1-C7-alkylene, with the proviso that a heterocyclic radical R3 is bonded via a ring carbon atom if X is not present;
- or a salt of the said compounds,
for the treatment of carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, tumors of the gastrointestinal tract, mesothelioma, esophageal tumors, stomach cancer, small-bowel tumors and large-bowel tumors such as polyps of the colon and rectum, and anorectal cancer. - A further aspect of the present invention is a method of inhibiting metastatic growth in a patient with a solid tumor disease selected from carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, tumors of the gastrointestinal tract, mesothelioma, esophageal tumors, stomach cancer, small-bowel tumors and large-bowel tumors such as polyps of the colon and rectum, and anorectal cancer which comprises administering to the patent a pharmaceutically effective amount of a 7H-pyrrolo[2,3-d]pyrimidine derivative of formula I wherein R1 and R2 are each independently of the other hydrogen, unsubstituted or substituted alkyl or cycloalkyl, a heterocyclic radical bonded via a ring carbon atom, or a radical of the formula R4—Y—(C═Z)— wherein R4 is unsubstituted, mono- or disubstituted amino or a heterocyclic radical, Y is either not present or lower alkyl and Z is oxygen, sulfur or imino, with the proviso that R1 and R2 are not both hydrogen; or R1 and R2 together with the nitrogen atom to which they are attached form a heterocyclic radical; R3 is a heterocyclic radical or an unsubstituted or substituted aromatic radical; G is C1-C7-alkylene, —C(═O)—, or C1-C6-alkylene-C(═O)— wherein the carbonyl group is attached to the NR1R2 moiety; Q is —NH— or —O—, with the proviso that Q is —O— if G is —C(═O)— or C1-C6-alkylene-C(═O)—; and X is either not present or C1-C7-alkylene, with the proviso that a heterocyclic radical R3 is bonded via a ring carbon atom if X is not present; or a salt of the said compounds, for the treatment of carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, tumors of the gastrointestinal tract, mesothelioma, esophageal tumors, stomach cancer, small-bowel tumors and large-bowel tumors such as polyps of the colon and rectum, and anorectal cancer.
- The general terms used hereinbefore and hereinafter preferably have within the context of this disclosure the following meanings, unless otherwise indicated:
- As used herein, the expression “week” means seven consecutive days. Thus, a three week period is twenty-one consecutive days starting on any day of the calendar week. The day that the first dose is given is considered to be the first day of the week. Any discussion using calendar weeks is intended to be for illustrative purposes only.
- As used herein, the expression “mesothelioma” means a malignant tumor derived from mesothelial tissue (peritoneum, pleura, pericardium).
- As used herein, the expression “glioma” preferably includes all primary intrinsic neoplasms of the brain and spinal cord, e.g. astrocytomas, ependymomas, neurocytomas or meningiomas.
- The term “tumors of the gastrointestinal tract” as used herein, includes, but is not limited to esophageal tumors, stomach cancer, small-bowel tumors and large-bowel tumors such as polyps of the colon and rectum, colorectal cancer and anorectal cancer.
- As used herein, the expression “partial response” means a greater than or equal to 50% reduction in measurable or evaluable disease in the absence of progression in any particular disease site.
- As used herein, the expression “stable disease” means a less than 50% decrease or less than 25% increase in measurable or evaluable disease.
- Asymmetric carbon atoms of a compound of formula I that are optionally present may exist in the (R), (S) or (R,S) configuration, preferably in the (R) or (S) configuration. Substituents at a double bond or a ring may be present in cis- (═Z—) or trans (═E—) form. The compounds may thus be present as mixtures of isomers or preferably as pure isomers.
- Preferably alkyl contains up to 20 carbon atoms and is most preferably lower alkyl.
- The prefix “lower” denotes a radical having up to and including a maximum of 7, especially up to and including a maximum of 4 carbon atoms, the radicals in question being either unbranched or branched with single or multiple branching.
- Lower alkyl is, for example, methyl, ethyl, n-propyl, isopropyl, n-butyl, isobutyl, sec-butyl, tert-butyl, n-pentyl, isopentyl, neopentyl, n-hexyl or n-heptyl.
- Alkyl R1 and R2 independently of each other are preferably methyl, ethyl, isopropyl or tert-butyl, especially methyl or ethyl.
- Lower alkyl Y is preferably methyl, ethyl or propyl.
- Lower alkoxy is for example ethoxy or methoxy, especially methoxy.
- Substituted alkyl is preferably lower alkyl as defined above where one or more, preferably one, substituents may be present, such as e.g. amino, N-lower alkylamino, N,N-di-lower alkylamino, N-lower alkanoylamino, N,N-di-lower alkanoylamino, hydroxy, lower alkoxy, lower alkanoyl, lower alkanoyloxy, cyano, nitro, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, amidino, guanidino, ureido, mercapto, lower alkylthio, halogen or a heterocyclic radical.
- Substituted alkyl R1 and R2 are independently of each other preferably hydroxy-lower alkyl, N,N-di-lower alkylamino-lower alkyl or morpholinyl-lower alkyl.
- Preferably unsubstituted or substituted cycloalkyl R1 or R2 contains from 3 up to 20 carbon atoms and is especially unsubstituted or also substituted C3-C6 cycloalkyl wherein the substituents are selected from e.g. unsubstituted or substituted lower alkyl, amino, N-lower alkylamino, N,N-di-lower alkylamino, N-lower alkanoylamino, N,N-di-lower alkanoylamino, hydroxy, lower alkoxy, lower alkanoyl, lower alkanoyloxy, cyano, nitro, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, amidino, guanidino, ureido, mercapto, lower alkylthio, halogen or a heterocyclic radical.
- Mono- or disubstituted amino is amino substituted by one or two radicals selected independently of one another from e.g. unsubstituted or substituted lower alkyl.
- Disubstituted amino R4 is preferably N,N-di-lower alkylamino, especially N,N-dimethylamino or N,N-diethylamino.
- A heterocyclic radical contains especially up to 20 carbon atoms and is preferably a saturated or unsaturated monocyclic radical having from 4 or 8 ring members and from 1 to 3 heteroatoms which are preferably selected from nitrogen, oxygen and sulfur, or a bi- or tri-cyclic radical wherein, for example, one or two carbocyclic radicals, such as e.g. benzene radicals, are annellated (fused) to the mentioned monocyclic radical. If a heterocyclic radical contains a fused carbocyclic radical then the heterocyclic radical may also be attached to the rest of the molecule of formula I via a ring atom of the fused carbocyclic radical. The heterocyclic radical (including the fused carbocyclic radical(s) if present) is optionally substituted by one or more, preferably by one or two, radicals such as e.g. unsubstituted or substituted lower alkyl, amino, N-lower alkylamino, N,N-di-lower alkylamino, N-lower alkanoylamino, N,N-di-lower alkanoylamino, hydroxy, lower alkoxy, lower alkanoyl, lower alkanoyloxy, cyano, nitro, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, amidino, guanidino, ureido, mercapto, lower alkylthio, or halogen.
- Most preferably a heterocyclic radical is pyrrolidinyl, piperidyl, lower alkyl-piperazinyl, di-lower alkyl-piperazinyl, morpholinyl, tetrahydropyranyl, pyridyl, pyridyl substituted by hydroxy or lower alkoxy, or benzodioxolyl, especially pyrrolidinyl, piperidyl, lower alkyl-piperazinyl, di-lower alkyl-piperazinyl or morpholinyl.
- A heterocyclic radical R1 or R2 is as defined above for a heterocyclic radical with the proviso that it is bonded to the rest of the molecule of formula I via a ring carbon atom. Preferably a heterocyclic radical R1 or R2 is lower alkyl-piperazinyl or especially preferred tetrahydropyranyl. If one of the two radicals R1 and R2 represents a heterocyclic radical, the other is preferably hydrogen.
- A heterocyclic radical R3 is as defined above for a heterocyclic radical with the proviso that it is bonded to Q via a ring carbon atom if X is not present. Preferably a heterocyclic radical R3 is benzodioxolyl, pyridyl substituted by hydroxy or lower alkoxy, or especially preferred indolyl substituted by halogen and lower alkyl. If R3 is pyridyl substituted by hydroxy then the hydroxy group is preferably attached to a ring carbon atom adjacent to the ring nitrogen atom.
- A heterocyclic radical R4 is as defined above for a heterocyclic radical and is preferably pyrrolidinyl, piperidyl, lower alkyl-piperazinyl, morpholinyl or pyridyl.
- If R1 and R2 together with the nitrogen atom to which they are attached form a heterocyclic radical, the heterocyclic radical is as defined above for a heterocyclic radical and represents preferably pyrrolidinyl, piperidyl, lower alkyl-piperazinyl, di-lower alkyl-piperazinyl or morpholinyl.
- An unsubstituted or substituted aromatic radical R3 has up to 20 carbon atoms and is unsubstituted or substituted, for example in each case unsubstituted or substituted phenyl. Preferably an unsubstituted aromatic radical R3 is phenyl. A substituted aromatic radical R3 is preferably phenyl substituted by one or more substituents selected independently of one another from the group consisting of unsubstituted or substituted lower alkyl, amino, N-lower alkylamino, N,N-di-lower alkylamino, N-lower alkanoylamino, N,N-di-lower alkanoylamino, hydroxy, lower alkoxy, lower alkanoyl, lower alkanoyloxy, cyano, nitro, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, amidino, guanidino, ureido, mercapto, lower alkylthio and halogen. Most preferably a substituted aromatic radical R3 is phenyl substituted by one or more radicals selected independently of one another from the group consisting of lower alkyl, amino, hydroxy, lower alkoxy, halogen and benzyloxy.
- Halogen is primarily fluoro, chloro, bromo or iodo, especially fluoro, chloro or bromo.
- C1-C7-alkylene may be branched or unbranched and is in particular C1-C3-alkylene.
- C1-C7-alkylene G is preferably C1-C3-alkylene, most preferably methylene (—CH2—).
- If G is not C1-C7-alkylene it preferably represents —C(═O)—.
- C1C7-alkylene X is preferably C1-C3-alkylene, most preferably methylene (—CH2—) or ethan-1,1-diyl (—CH(CH3)—).
- Q is preferably —NH—.
- Z is preferably oxygen or sulfur, most preferably oxygen.
- Salts are especially the pharmaceutically acceptable salts of compounds of formula I.
- Special preference is given to a compound of formula I, wherein
- R1 and R2 are each independently of the other hydrogen, lower alkyl, hydroxy-lower alkyl, or a radical of the formula R4—Y—(C═Z)— wherein R4 is di-lower alkylamino, pyrrolidinyl, piperidyl, lower alkyl-piperazinyl, morpholinyl or pyridyl, Y is either not present or lower alkyl and Z is oxygen, with the proviso that R1 and R2 are not both hydrogen; or
- R1 and R2 together with the nitrogen atom to which they are attached form a radical selected from the group consisting of pyrrolidinyl, piperidyl, lower alkyl-piperazinyl, di-lower alkyl-piperazinyl and morpholinyl;
- R3 is phenyl, benzodioxolyl, pyridyl substituted by hydroxy or lower alkoxy, or phenyl substituted by one or more radicals selected independently of one another from the group consisting of lower alkyl, hydroxy, lower alkoxy, halogen and benzyloxy;
- G is —CH2—;
- Q is —NH—; and
- X is either not present, —CH2— or —CH(CH3)—, with the proviso that substituted pyridyl R3 is bonded via a ring carbon atom if X is not present;
- or a salt thereof.
- The compounds of formula I or salts thereof are prepared in accordance with processes known per se (see also EP 682 027, WO 97/02266, WO 97/27199 and WO 98/07726), though not previously described for the manufacture of the compounds of the formula I, especially whereby in order to prepare a compound of formula I, wherein G is C1-C7-alkylene and wherein R1 and R2 are each independently of the other hydrogen, unsubstituted or substituted alkyl or cycloalkyl, or a heterocyclic radical bonded via a ring carbon atom, with the proviso that R1 and R2 are not both hydrogen, or wherein R1 and R2 together with the nitrogen atom to which they are attached form a heterocyclic radical, a compound of the formula II
wherein Hal is halogen, G is C1-C7-alkylene and R3, Q and X have the meanings as defined for a compound of formula I, is reacted with a compound of the formula III
wherein R1 and R2 are each independently of the other hydrogen, unsubstituted or substituted alkyl or cycloalkyl, or a heterocyclic radical bonded via a ring carbon atom, with the proviso that R1 and R2 are not both hydrogen, or wherein R1 and R2 together with the nitrogen atom to which they are attached form a heterocyclic radical;
whereby functional groups which are present in the starting compounds of processes a) to d) and are not intended to take part in the reaction, are present in protected form if necessary, and protecting groups that are present are cleaved, whereby the said starting compounds may also exist in the form of salts provided that a salt-forming group is present and a reaction in salt form is possible;
and, if so desired, a compound of formula I thus obtained is converted into another compound of formula I, a free compound of formula I is converted into a salt, an obtained salt of a compound of formula I is converted into the free compound or another salt, and/or a mixture of isomeric compounds of formula I is separated into the individual isomers. - The reaction between a compound of formula II and a compound of formula III preferably takes place in a suitable inert solvent, especially N,N-dimethylformamide, in the presence of a base such as potassium carbonate, at temperatures from room temperature (RT) to 100° C. Alternatively, the reaction between a compound of formula II and a compound of formula III takes place in a suitable solvent, e.g. lower alcohols, such as ethanol, in the presence of for example a suitable catalyst such as NaI, preferably at the reflux temperature of the solvent employed. In a compound of formula II, Hal is preferably chloro.
- In the additional process steps, carried out as desired, functional groups of the starting compounds which should not take part in the reaction may be present in unprotected form or may be protected for example by one or more protecting groups. The protecting groups are then wholly or partly removed according to one of the known methods.
- Protecting groups, and the manner in which they are introduced and removed are described, for example, in “Protective Groups in Organic Chemistry”, Plenum Press, London, New York 1973, and in “Methoden der organischen Chemie”, Houben-Weyl, 4th edition, Vol. 15/1, Georg-Thieme-Verlag, Stuttgart 1974 and in Theodora W. Greene, “Protective Groups in Organic Synthesis”, John Wiley & Sons, New York 1981. A characteristic of protecting groups is that they can be removed readily, i.e. without the occurrence of undesired secondary reactions, for example by solvolysis, reduction, photolysis or alternatively under physiological conditions.
- The end products of formula I may however also contain substituents that can also be used as protecting groups in starting materials for the preparation of other end products of formula I. Thus, within the scope of this text, only a readily removable group that is not a constituent of the particular desired end product of formula I is designated a “protecting group”, unless the context indicates otherwise.
- All process steps described here can be carried out under known reaction conditions, preferably under those specifically mentioned, in the absence of or usually in the presence of solvents or diluents, preferably those that are inert to the reagents used and able to dissolve them, in the absence or presence of catalysts, condensing agents or neutralising agents, for example ion exchangers, typically cation exchangers, for example in the H+ form, depending on the type of reaction and/or reactants at reduced, normal, or elevated temperature, for example in the range from −100° C. to about 190° C., preferably from about −80° C. to about 150° C., for example at −80 to −60° C., at RT, at −20 to 40° C., at 0 to 100° C. or at the boiling point of the solvent used, under atmospheric pressure or in a closed vessel, if need be under pressure, and/or in an inert, for example an argon or nitrogen, atmosphere.
- The starting materials used in the above described processes a) to b) are known, capable of being prepared according to known processes (see also EP 682 027, WO 97/02266, WO 97/27199 and WO 98/07726), or commercially obtainable; in particular, they can be prepared using processes as described in the Examples.
- In the preparation of starting materials, existing functional groups which do not participate in the reaction should, if necessary, be protected. Preferred protecting groups, their introduction and their removal are described above or in the Examples. Where the term starting materials is used hereinbefore and hereinafter, the salts thereof are always included, insofar as reasonable and possible.
- A compound of formula II can be prepared for example by reacting a compound of formula VII
wherein G is C1-C7-alkylene and R3, Q and X have the meanings as defined for a compound of formula I, with e.g. thionyl halogenide, preferably thionyl choride, in the presence or absence of pyridine, in an inert solvent, for example toluene or in a 1:1 mixture of acetonitrile and dioxane, preferably at −10 to 0° C. or at RT. - A compound of formula VII can be prepared for example by reacting a compound of formula VIII
wherein R5 is lower alkyl, especially methyl or ethyl, and R3, Q and X have the meanings as defined for a compound of formula I, with lithium aluminium hydride, in an inert solvent, especially ethers, e.g. cyclic ethers such as tetrahydrofuran, preferably at the reflux temperature of the solvent employed. Alternatively, a compound of formula VII may be prepared by reacting a compound of formula VIII with diisobutyl-aluminium hydride, in an inert solvent, for example in tetrahydrofuran or in a 1:1 mixture of dichloromethane and dioxane, preferably at RT. - A compound of formula VIII wherein Q is —NH— can be prepared for example by reacting a compound of formula IX
wherein Hal is halogen, preferably chloro, and R5 is as defined above for a compound of formula VIII, with a compound of the formula H2N—X—R3, wherein R3 and X have the meanings as defined for a compound of formula I, (i) in a suitable solvent such as alcohols, especially lower alcohols such as n-butanol, preferably at the boiling temperature of the solvent employed or (ii) under catalytic conditions. - A compound of formula VIII wherein Q is —O— can be prepared for example by reacting a compound of formula IX, which is preferably N-protected in the pyrrolo-pyrimidine moiety, with a compound of the formula HO—X—R3, wherein R3 and X have the meanings as defined for a compound of formula I, in a suitable inert solvent such as N,N-dimethylformamide and in the presence of a base such as potassium carbonate, at elevated temperatures, preferably at around 100° C.
- Alternatively, the carboxylic acid ester of a compound of formula IX may first be reduced to the corresponding alcohol, e.g. under conditions described above for the preparation of a compound of formula VII, and then either be reacted with a compound of the formula H2N—X—R3, e.g. under conditions described above for the preparation of a compound of formula VIII wherein Q is —NH—, or be reacted with a compound of the formula HO—X—R3, e.g. under conditions described above for the preparation of a compound of formula VIII wherein Q is —O—.
- A compound of formula I, or a pharmaceutically acceptable salt thereof, can be used in pharmaceutical compositions known as such. Compositions for enteral administration, such as nasal, buccal, rectal or, especially, oral administration, and for parenteral administration, such as intravenous, intramuscular or subcutaneous administration, to warm-blooded animals, especially humans, are especially preferred. The compositions contain the active ingredient alone or, preferably, together with a pharmaceutically acceptable carrier. The dosage of the active ingredient depends upon the disease to be treated and upon the species, its age, weight, and individual condition, the individual pharmacokinetic data, and the mode of administration. The pharmaceutical compositions comprise from approximately 1% to approximately 95% active ingredient, single-dose administration forms comprising in the preferred embodiment from approximately 20% to approximately 90% active ingredient and forms that are not of single-dose type comprising in the preferred embodiment from approximately 5% to approximately 20% active ingredient. Unit dose forms are, for example, coated and uncoated tablets, ampoules, vials, suppositories or capsules. Examples are capsules containing from about 0.05 g to about 1.0 g of active substance.
- The pharmaceutical compositions of the present invention are prepared in a manner known per se, for example by means of conventional mixing, granulating, coating, dissolving or lyophilising processes.
- The structure of the active agents identified by code nos., generic or trade names may be taken from the actual edition of the standard compendium “The Merck Index” or from databases, e.g. Patents International (e.g. IMS World Publications). The corresponding content thereof is hereby incorporated by reference.
- In one preferred embodiment of the invention, the solid tumor disease to be treated is renal cell cancer. In another preferred embodiment of the invention, the solid tumor disease to be treated is NSCLC. In a further preferred embodiment of the invention, the solid tumor disease to be treated is selected from skin squamous cell carcinoma and head and neck squamous cell carcinoma. In another preferred embodiment of the invention, the solid tumor disease is anorectal cancer, especially anorectal adenocarcinoma and squamous cell carcinoma of the anal canal and margin and metastasis thereof.
- In one embodiment the present invention relates to a treatment regimen whereby the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered to the human subject less frequently than on a daily basis. In particular, the present invention relates to a treatment regimen whereby over at least a three week period, the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered on only about 40% to about 71% of the days. In such embodiment, specifically, the present invention relates to a method of treating a human subject with a 7H-pyrrolo[2,3-d]pyrimidine derivative, which comprises administering such pyrimidine derivative to the human subject from three to five times in each seven day period for a period of three weeks or longer, more specifically, three or four times a week on alternate days for a period of three weeks or longer. In a specific embodiment, the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered three times each week on alternate days, for example, on Monday, Wednesday and Friday of each week, for at least three weeks. Thus, the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered every other day until three doses are given and the next dose is administered at the beginning of the following week. Preferably, such dosage regimen is carried out through at least four or more weeks, for example 4, 5, 6, 7 or 8 weeks. Alternatively, the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered daily for a period of one to three weeks, e.g. two weeks, followed by a period of one to three weeks, e.g. two weeks without administering the compound to the patient.
- Thus, the present invention relates especially to a method of treating a solid tumor disease as defined herein, which comprises administering a pharmaceutically effective amount of (R)-6-(4-hydroxy-phenyl)-4-[(1-phenyl-ethyl)-amino]-7H-pyrrolo[2,3-d]pyrimidine, or a salt thereof, to a human subject, preferably three or four times a week on alternate days, more preferably three times a week on alternate days, for a period of three weeks or longer.
- The inventive dosage regimen applies to the use of 7H-pyrrolo[2,3-d]pyrimidine derivative, for example, PKI166, alone, or as part of a combination treatment therapy wherein it is co-administered with one or more additional pharmaceutical products useful for treating tumors, especially cancerous tumors. For purposes of this application co-administered means that the patient is treated with both drugs according to the proper schedule for each, but not necessarily that both drugs are administered together at the same time. Thus, the 7H-pyrrolo[2,3-d]pyrimidine derivative, may be administered alone or in combination with other anticancer agents, e.g. in accordance with the present inventive dosage regimen.
- The 7H-pyrrolo[2,3-d]pyrimidine derivative is advantageously administered to the human subject at a pharmaceutically effective dosage in the range of from about 50 mg to about 2000 mg on days when the 7H-pyrrolo[2,3-d]pyrimidine derivative is administered. When PKI166 is employed, the preferred effective dose is in the range from about 50 mg to about 2000 mg, for example, about 450 mg to about 1500 mg doses or about 500 mg to about 1200 mg doses.
- The 7H-pyrrolo[2,3-d]pyrimidine derivative is administered to the subject by methods known in the art for administering pharmaceutical products, for example, orally, rectally or parenterally, preferably orally as a tablet or capsule formulation. Especially, the 7H-pyrrolo[2,3-d]pyrimidine derivative can be administered as described in WO 97/02266.
- The effect of a 7H-pyrrolo[2,3-d]pyrimidine derivative against the tumor types mentioned herein can be demonstrated, e.g., in suitable tumor models utilising cells lines, e.g. models utilising the cell lines NCI-H529 SCC (lung) or orthotopic 253J B-V (bladder).
- The following Examples illustrate the invention described above; they are not, however, intended to limit the scope of the invention in any way. The beneficial effects of the 7H-pyrrolo[2,3-d]pyrimidine derivatives can also be determined by other test models known as such to the person skilled in the pertinent art.
- A mixture of 10.8 g (30 mmol) [6-(4-chloromethyl-phenyl)-7H-pyrrolo[2,3-d]pyrimidin-4-yl]-((R)-1-phenyl-ethyl)-amine in 450 ml DMF is treated with 6.8 ml (63 mmol) N-methyl-piperazine and 20.7 g (150 mmol) anhydrous potassium carbonate and the mixture heated to 65° C. for 1 hour. The reaction mixture is cooled and the inorganic salts removed by filtration (Hyflo Super Cel®; Fluka, Buchs, Switzerland). The DMF is evaporated under reduced pressure and the residue purified through flash chromatography using first dichloro-methane/ethanol 9:1 and then dichloromethane/ethanol 9:1 plus 1% conc. ammonia. Crystallization of the pure fractions from THF (20 ml) and hexanes (80 ml) gives the title compound; m.p. 248-250° C.; MS-ES+: (M+H)+=427.
- Step 1.1: 4-[4-((R)-1-Phenyl-ethylamino)-7H-pyrrolo[2,3-d]pyrimidin-6-yl]-benzoic acid ethyl ester
- 1.8 g (6 mmol) 4-(4-chloro-7H-pyrrolo[2,3-d]pyrimidin-6-yl)-benzoic acid ethyl ester (WO 97/02266) are suspended in 40 ml n-butanol and treated with 1.5 ml (12 mmol) (R)-phenethylamine. The mixture is heated to 145° C. under stirring. After 3 h a clear brown solution is obtained which is treated with a second portion of (R)-phenethylamine (0.75 ml, 6 mmol). After stirring for additional 2 h the reaction mixture is cooled in an ice bath and the title compound filtered and washed with cold n-butanol and ether; m.p. 288-290° C.
- Step 1.2: {4-[4-((R)-1-Phenyl-ethylamino)-7H-pyrrolo[2,3-d]pyrimidin-6-yl]-phenyl}-methanol
- 570 mg (15 mmol) lithium aluminum hydride are suspended in 150 ml dry THF at RT. 1.23 g (3-mmol) 4-[4-((R)-1-phenyl-ethylamino)-7H-pyrrolo[2,3-d]pyrimidin-6-yl]-benzoic acid ethyl ester are added and the mixture heated to reflux for 1 h. The mixture is cooled in an ice bath and treated sequentially with water (0.57 ml), 15% sodium hydroxide solution (0.57 ml) and water (1.71 ml). The solid aluminum complex is removed by filtration (Hyflo Super Cel®; Fluka, Buchs, Switzerland), the filtrate dried over sodium sulfate evaporated. The residue is suspended in water, filtered and dried to give the title compound; m.p. >300° C.; Rf (dichloromethane/ethanol 9:1 plus 1% conc. ammonia)=0.43.
- Step 1.3: [6-(4-Chloromethyl-phenyl)-7H-pyrrolo[2,3-d]pyrimidin-4-yl]-((R)-1-phenyl-ethyl)-amine
- A solution of thionyl chloride (25.7 ml, 0.328 mol) in 180 ml of toluene is cooled to −10° C. Solid {4-[4-((R)-1-phenyl-ethylamino)-7H-pyrrolo[2,3-d]pyrimidin-6-yl]-phenyl}-methanol (11.3 g, 0.0328 mol) is added in 8 portions over a range of 1 h. The temperature is then increased slowly to 0° C. and the mixture stirred for 2 h. The cold reaction mixture is filtered and the solid washed with toluene and ether. The crude product is suspended in water and treated with saturated sodium bicarbonate solution until the mixture turns basic. The mixture is stirred well for about 10 min and filtered. The solid is thoroughly washed with water and dried under reduced pressure to give the title compound; m.p. >320° C.; Rf (dichloromethane/ethanol 9:1)=0.46.
- The following Examples are synthesized from [6-(4-chloromethyl-phenyl)-7H-pyrrolo[2,3-d]pyrimidin-4-yl]-((R)-1-phenyl-ethyl)-amine using an analogous procedure described in Example 1:
Exam- m.p. ple Name [° C. ] 2 [6-(4-Diethylaminomethyl-phenyl)-7H-pyrrolo[2,3- 246-248 d]pyrimidin-4-yl]-((R)-1-phenyl-ethyl)-amine 3 {6-[4-(4-Ethyl-piperazin-1-ylmethyl)-phenyl]-7H- 245-247 pyrrolo[2,3-d]pyrimidin-4-yl}-((R)-1-phenyl-ethyl)- amine 4 ((R)-1-Phenyl-ethyl)-[6-(4-pyrrolidin-1-ylmethyl- 254-256 phenyl)-7H-pyrrolo[2,3-d]pyrimidin-4-yl]-amine 5 [6-(4-Dimethylaminomethyl-phenyl)-7H- 241-243 pyrrolo[2,3-d]pyrimidin-4-yl]-((R)-1-phenyl-ethyl)- amine 6 ((R)-1-Phenyl-ethyl)-[6-(4-piperidin-1-ylmethyl- 246-248 phenyl)-7H-pyrrolo[2,3-d]pyrimidin-4-yl]-amine 7 [6-(4-Morpholin-4-ylmethyl-phenyl)-7H- 263-265 pyrrolo[2,3-d]pyrimidin-4-yl]-((R)-1-phenyl-ethyl)- amine 8 {6-[4-(3,5-Dimethyl-piperazin-1-ylmethyl)-phenyl]- 208-210 7H-pyrrolo[2,3-d]pyrimidin-4-yl}-((R)-1-phenyl- ethyl)-amine 9 (6-{4-[(2-Morpholin-4-yl-ethylamino)-methyl]- 222-224 phenyl}-7H-pyrrolo[2,3-d]pyrimidin-4-yl)-((R)-1- phenyl-ethyl)-amine 10 ((R)-1-Phenyl-ethyl)-(6-{4-[(tetrahydro-pyran-4- 253-255 ylamino)-methyl]-phenyl}-7H-pyrrolo[2,3- d]pyrimidin-4-yl)-amine - A human patient suffering from renal cell cancer is treated for a period of 16 weeks in 4 cycles consisting of administration of 600 mg of PKI166 daily for two weeks followed by 2 weeks without administering the drug. During such 16 weeks a stable disease is observed.
- A human patient suffering from renal cell cancer is treated for a period of 16 weeks with 400 mg of PKI166 on Monday, Wednesday and Friday of each week. During such 16 weeks a stable disease is observed.
- A human patient suffering from NSCLC is treated for a period of 8 weeks with 450 mg/day of PKI166 except on day 2, 16 and 30 on which days no drug is applied. After such treatment a partial response is observed.
Claims (10)
1-14. (canceled)
15: The use of a 7H-pyrrolo[2,3-d]pyrimidine derivative of the following formula (I′)
wherein
q is 0 or 1;
n is from 1-3 when q is 0, or n is from 0-3 when q is 1;
R is halogen, lower alkyl, hydroxy, lower alkanoyloxy, lower afkoxy, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, cyano, amino, lower alkanoylamino, lower alkylamino, N,N-di-lower alkylamino or tri-fluoromethyl, it being possible when several radicals R are present in the molecule for those radicals to be identical or different;
a) R1 and R2 are each independently of the other
α) phenyl substituted by carbamoyl-methoxy, carboxy-methoxy, benzyloxycarbonyl-methoxy, lower alkoxycarbonyl-methoxy, phenyl, amino, lower alkanoylamino, lower alkylamino, N,N-di-lower alkylamino, hydroxy, lower alkanoyloxy, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, cyano or by nitro;
β) hydrogen with the proviso that R1 and R2 are not hydrogen simultaneously;
γ) unsubstituted or halo- or lower alkyl-substituted pyridyl;
δ) N-benzyl-pyridinium-2-yl, naphthyl, cyano, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, N-benzyl-carbamoyl, formyl, lower alkanoyl, lower alkenyl, lower alkenyloxy; or
ε) lower alkyl substituted by
εα) halogen, amino, lower alkylamino, piperazino, di-lower alkylamino,
εβ) phenylamino that is unsubstituted or substituted in the phenyl moiety by halogen, lower alkyl, hydroxy, lower alkanoyloxy, lower alkoxy, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, cyano, amino, lower alkanoylamino, lower alkylamino, N,N-di-lower alkylamino or by trifluoromethyl,
εγ) hydroxy, lower alkoxy, cyano, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl, mercapto or
εδ) by a radical of the formula R3—S(O)m-, wherein R3 is lower alkyl and m is 0, 1 or 2; or
b) when q is 0, one of the radicals R1 and R2 is unsubstituted lower alkyl or unsubstituted phenyl and the other of the radicals R1 and R2 has one of the meanings given above in paragraph a) with the exception of hydrogen; or
c) when q is 0 and R is carboxy, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl or lower alkanoyl-amino, R1 and R2 together are C4-C10-1,4-alkadienylene substituted by amino, lower alkanoylamino, lower alkylamino, N,N-di-lower alkylamino, nitro, halogen, hydroxy, lower alkanoyloxy, carboxy, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl, N,N-di-lower alkyl-carbamoyl or by cyano, or are aza-1,4-alkadienylene having up to 9 carbon atoms; or
d) when q is 1, R1 and R2 are each independently of the other unsubstituted lower alkyl or unsubstituted phenyl or have one of the meanings given above in paragraph a), and R6 is hydrogen, lower alkyl, lower alkoxycarbonyl, carbamoyl, N-lower alkyl-carbamoyl or N,N-di-lower alkyl-carbamoyl, with the exception of the compound of formula (I), wherein n is 0, q is 1, R1 and R6 are each hydrogen and R2 is methyl, the compound of formula (I′), wherein n is 2, q is 1, R1 and R6 are each hydrogen, R2 is methyl and R is 3,4-methoxy and the compounds of formula (I′), wherein n is 1, q is 0, R1 is 3-pyridyl, 4-cyanophenyl or 4-hydroxyphenyl, R2 is hydrogen and R is fluoro, and wherein the prefix “lower” denotes a radical having up to and including a maximum of 7 carbon atoms;
or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the treatment of renal carcinoma.
16: The use according to claim 15 , wherein the 7H-pyrrolo[2,3-d]pyrimidine derivative of formula (I′) is (R)-6-(4-hydroxy-phenyl)-4-[(1-phenyl-ethyl)-amino]-7H-pyrrolo[2,3-d]pyrimidine.
17: A method for the treatment of patient suffering from renal carcinoma comprising administering a pharmaceutically effective amount of a 7H-pyrrolo[2,3-d]pyrimidine derivative of formula (I′) according to claim 15 , or a pharmaceutically acceptable salt thereof, to the patient.
18: The method of claim 17 , wherein the pharmaceutically effective dose is in the range from about 50 mg to about 2000 mg.
19: A method of inhibiting metastatic growth in a patient with a renal carcinoma which comprises administering a pharmaceutically effective amount of a 7H-pyrrolo[2,3-d]pyrimidine derivative of formula (I′) according to claim 15 , or a pharmaceutically acceptable salt thereof, to the patient.
20: Use of a 7H-pyrrolo[2,3-d]pyrimidine derivative of formula (I)
wherein
R1 and R2 are each independently of the other hydrogen, unsubstituted or substituted alkyl or cycloalkyl, a heterocyclic radical bonded via a ring carbon atom, or a radicat of the formula R4—Y—(C═Z)—, wherein R4 is unsubstituted, mono- or disubstituted amino or a heterocyclic radical, Y is either not present or lower alkyl and Z is oxygen, sulfur or imino, with the proviso that R1 and R2 are not both hydrogen; or
R1 and R2, together with the nitrogen atom to which they are attached, form a heterocyclic radical;
R3 is a heterocyclic radical or an unsubstituted or substituted aromatic radical;
G is C1-C7-alkylene, —C(═O)—, or C1-C6-alkylene-C(═O)—, wherein the carbonyl group is attached to the NR1R2 moiety;
Q is —NH— or —O—, with the proviso that Q is —O— if G is —C(═O)— or C1-C6-alkylene-C(═O)—; and
X is either not present or C1-C7-alkylene, with the proviso that a heterocyclic radical R3 is bonded via a ring carbon atom if X is not present;
or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for the treatment of carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, tumors of the gastrointestinal tract, mesothelioma, esophageal tumors, stomach cancer, small-bowel tumors and large-bowel tumors such as polyps of the colon and rectum and anorectal cancer.
21: A method for the treatment of patients suffering from a solid tumor disease selected from carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, tumors of the gastrointestinal tract, mesothelioma, esophageal tumors, stomach cancer, small-bowel tumors and large-bowel tumors, such as polyps of the colon and rectum and anorectal cancer, comprising administering to the patient a pharmaceutically effective amount of a 7H-pyrrolo[2,3-d]pyrimidine derivative of formula (I) according to claim 20 or a pharmaceutically acceptable salt of said compound.
22: The method of claim 21 , wherein the pharmaceutically effective dose is in the range from about 50 mg to about 2000 mg.
23: A method of inhibiting metastatic growth in a patient with a solid tumor disease selected from carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, tumors of the gastrointestinal tract, mesothelioma, esophageal tumors, stomach cancer, small-bowel tumors and large-bowel tumors, such as polyps of the colon and rectum and anorectal cancer which comprises administering to the patient a pharmaceutically effective amount of a 7H-pyrrolo[2,3-d]pyrimidine derivative of formula (I) according to claim 20 or a salt of the said compounds, for the treatment of carcinoma of the bladder, renal carcinoma, squamous cell carcinoma of the skin, tumors of the gastrointestinal tract, mesothelioma, esophageal tumors, stomach cancer, small-bowel tumors and large-bowel tumors, such as polyps of the colon and rectum and anorectal cancer.
Priority Applications (1)
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US10/493,787 US20050038048A1 (en) | 2001-10-29 | 2002-10-28 | Use of 7h-pyrrollo{2,3-d}pyrimidine derivatives in the treatment of solid tumor diseases |
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US34092301P | 2001-10-29 | 2001-10-29 | |
US36165502P | 2002-03-05 | 2002-03-05 | |
US37936502P | 2002-05-09 | 2002-05-09 | |
PCT/EP2002/012024 WO2003037897A2 (en) | 2001-10-29 | 2002-10-28 | Use of 7h-pyrrolo[2,3-d]pyrimidine derivatives in the treatment of solid tumor diseases |
US10/493,787 US20050038048A1 (en) | 2001-10-29 | 2002-10-28 | Use of 7h-pyrrollo{2,3-d}pyrimidine derivatives in the treatment of solid tumor diseases |
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US (1) | US20050038048A1 (en) |
EP (1) | EP1441736A2 (en) |
JP (1) | JP2005507424A (en) |
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EP2314295A1 (en) | 2005-07-29 | 2011-04-27 | Resverlogix, Inc | Pharmaceutical compositions for the prevention and treatment of complex diseases and their delivery by insertable medical devices |
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WO2005039588A2 (en) * | 2003-10-22 | 2005-05-06 | Novartis Ag | Methods for determining the risk of developing liver and lung toxicity |
PE20051092A1 (en) * | 2004-01-29 | 2006-01-20 | Novartis Ag | PYROLO-PYRIMIDINE DERIVATIVES USEFUL FOR THE TREATMENT OF PROLIFERATIVE DISEASES |
GB0403606D0 (en) * | 2004-02-18 | 2004-03-24 | Novartis Ag | Organic compounds |
EP1827437B1 (en) | 2004-12-15 | 2011-11-02 | Novartis AG | Combinations of therapeutic agents for treating cancer |
AU2007206925A1 (en) * | 2006-01-23 | 2007-07-26 | Novartis Ag | Solid forms of a pyrrolopyrimidine derivative and their use as anti-tumor agents |
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DK0836605T3 (en) * | 1995-07-06 | 2002-05-13 | Novartis Ag | Pyrrolopyrimidines and Methods for their Preparation |
DE69712745T2 (en) * | 1996-01-23 | 2002-10-31 | Novartis Ag, Basel | PYRROLOPYRIMIDINES AND METHOD FOR THE PRODUCTION THEREOF |
GB9925958D0 (en) * | 1999-11-02 | 1999-12-29 | Bundred Nigel J | Therapeutic use |
US7344829B2 (en) * | 2000-11-03 | 2008-03-18 | Board Of Regents, The University Of Texas System | Methods for detecting the efficacy of anticancer treatments |
AU2002223684A1 (en) * | 2000-11-22 | 2002-06-03 | Novartis Pharma Gmbh | Combination comprising an agent decreasing vegf activity and an agent decreasing egf activity |
CN1511036B (en) * | 2001-02-27 | 2010-05-05 | 诺瓦提斯公司 | Combination comprising signal transduction inhibitor and epothilone derivative |
-
2002
- 2002-10-28 US US10/493,787 patent/US20050038048A1/en not_active Abandoned
- 2002-10-28 JP JP2003540178A patent/JP2005507424A/en not_active Ceased
- 2002-10-28 EP EP02781294A patent/EP1441736A2/en not_active Withdrawn
- 2002-10-28 WO PCT/EP2002/012024 patent/WO2003037897A2/en active Application Filing
- 2002-10-28 AU AU2002349013A patent/AU2002349013A1/en not_active Abandoned
Cited By (1)
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EP2314295A1 (en) | 2005-07-29 | 2011-04-27 | Resverlogix, Inc | Pharmaceutical compositions for the prevention and treatment of complex diseases and their delivery by insertable medical devices |
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EP1441736A2 (en) | 2004-08-04 |
WO2003037897A2 (en) | 2003-05-08 |
AU2002349013A1 (en) | 2003-05-12 |
JP2005507424A (en) | 2005-03-17 |
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